Individual
RYAN HYDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2605 W PRIMROSE LN, SPRINGFIELD, MO 65807-8613
(417) 872-6823
Mailing address
2605 W PRIMROSE LN, SPRINGFIELD, MO 65807-8613
(417) 872-6823
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18415
FL
224Z00000X
Occupational Therapy Assistant
2014022930
MO
Other
Enumeration date
07/29/2014
Last updated
08/27/2021
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